How to Avoid COVID-19, Flu, and RSV This Holiday Season
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Whether you’re getting on a plane to visit extended family for Thanksgiving or Christmas or planning a New Year’s Eve party at home, you may be preparing to gather with the people you love during the holiday season.
Unfortunately the holiday months are prime time for respiratory viruses like COVID-19, flu, and RSV (respiratory syncytial virus).
How bad will the upcoming respiratory virus season be? The Centers for Disease Control and Prevention (CDC) predicts this year will likely be a repeat of last year, which means an uptick in hospitalizations compared with pre-pandemic seasons.
Some experts are more optimistic. “I’m hoping that this is a more ‘normal’ year for community-associated respiratory viruses,” says Dean Blumberg, MD, a professor in the division of pediatric infectious diseases and a COVID-19 expert at UC Davis in California. “Last year was unusual, likely due to all the social distancing and masking during the first years of COVID-19 leading to an all-time low in other respiratory viral transmission [like flu and RSV], followed by the big rebound last fall,” he says.
Dr. Blumberg’s “normal” scenario would include a gradual increase in RSV infections starting in the fall and leading to sustained transmission through March; an increase in influenza cases likely cresting sometime in December through April; and an increase in COVID-19 cases — but hopefully not a surge.
Even in this vision of a “new normal,” it’s clear that COVID-19, flu, and RSV will be circulating over the holidays, with travel and social gatherings facilitating the spread.
But there are ways to decrease the risk. Here’s what experts recommend when it comes to keeping you and yours safe in the coming months.
1. Get Your Flu Shot
At this time of year and moving into the winter, even people who are vaccinated against COVID-19 are susceptible to other germs such as those that cause the flu.
If you’ve been wondering how to time your flu shot this year, get it now if you haven’t already, says Blumberg. “I always recommend influenza vaccine yearly, and now is a good time to get it if you haven’t already. Early indications are that this year’s influenza vaccine will be a good match with expected circulating strains,” he says.
Also, some people are not aware that if you get the flu despite being vaccinated, the disease is likely to be milder than if you were unvaccinated, he adds.
2. Get Up to Date on Your COVID-19 Vaccination
“I’m enthusiastic about the new COVID-19 vaccine and recommend everyone 6 months of age and older get it,” says Blumberg.
The current monovalent COVID-19 vaccine is based on the XBB.1.5 strain, a subvariant of omicron that dominated the United States and the world from November 2020 until early this year, according to Yale Medicine.
Although that strain is no longer dominant, the COVID-19 vaccine still results in better immune responses against currently circulating strains compared with the previous bivalent vaccine, Blumberg says.
“We do expect an uptick in COVID-19 transmission this winter, so now is a good time to get this vaccination,” he adds.
Experts recommend waiting two months after your last COVID-19 vaccination before getting the updated shot. If you recently had COVID-19, the CDC says you can consider waiting 90 days.
3. Over 60? Talk With Your Doctor About Getting the RSV Vaccine
“For the RSV vaccine in older adults, I agree with the CDC advice to talk with your doctor,” says Blumberg. He adds, “People who are older and have more risk factors for severe disease [such as lung or heart disease, weakened immune systems, diabetes, or kidney or liver disease] should strongly consider getting the RSV vaccine.”
4. Get Your Vaccines at Least 2 Weeks Before Holiday Travel or Gathering
If you plan to travel or get together with family and friends, plan to get your vaccines in time to fully protect yourself and others, according to the American Association of Medical Colleges (AAMC).
Immunity develops over one to two weeks after immunization.
5. Stay Home if You Have Symptoms of COVID-19, Flu, or RSV
The guidance is clear on this: If you have any symptoms or COVID-19, flu, or RSV — including runny nose, sore throat, cough, headache, or fever — you should stay at home until you’re feeling much better, even if you test negative for COVID-19, says Nandita Mani, MD, an infectious-disease specialist and hospitalist at UW Medicine in Seattle.
“Viruses like flu and RSV can have serious consequences in small children, pregnant people, and older or otherwise vulnerable individuals,” she says.
If a person truly has cold symptoms (and there isn’t an alternative noninfectious explanation, like allergies), then they should avoid gatherings even if they test negative for COVID-19, says Blumberg: “It could be influenza, RSV or other respiratory virus, and that’s not a gift you want to give your friends and family.”
Sajal Tanna, MD, MPH, an infectious-disease doctor at Inova Health System in Falls Church, Virginia, agrees.
It’s important to recognize that many symptoms that may seem fairly innocuous might not be, says Dr. Tanna. “A lot of people I’ve seen who have had COVID-19 chalk up their symptoms to allergies or a cold, or say, ‘Oh, I just have a headache because of my period.’ It’s very easy to explain things away, but I think everything should be considered COVID-19 until proven otherwise,” she says.
6. Utilize COVID-19 Testing or Masking to Help Limit Virus Spread
“For gatherings, I hope that most people are screening themselves for symptoms and that they have the courtesy for others to avoid the gatherings if symptomatic. If there are people at much higher risk for severe disease attending, then I recommend either testing the day of, or masking if not testing,” says Blumberg.
Testing is a great tool in our COVID-19 safety toolbox, regardless of vaccination status, says Dr. Mani. Whether you’re taking a PCR or a home antigen test, the key is to test as close to the event as possible, she says.
Antigen (rapid) home tests are less accurate than PCR tests, but they can provide results in minutes, per the CDC.
Home COVID-19 antigen tests are quick and convenient, but if you’re asymptomatic or have an early-stage infection, they’re less likely to be accurate than PCR tests. If you have symptoms or you were recently exposed to COVID-19, you should interpret a negative home test with caution, says the CDC.
“Rapid tests should be done 48 hours prior to your gathering, the day of, and 48 hours after arrival and every two to three days thereafter. Do not travel if symptomatic; even if your rapid test is negative, often it will turn positive by day three to five,” says Purvi Parikh, MD, a clinical assistant professor at NYU Grossman School of Medicine and an immunologist at NYU Langone in New York City.
7. Mask Up if You Have to Fly or Use Public Transportation
For everyone age 2 and older, wearing a mask in indoor areas of public transportation — buses, subways, trains, and airplanes — can help limit the spread of respiratory diseases, according to the CDC.
“I’m a big believer in continuing to mask during high-risk situations such as airplane travel: You are sitting very close to people, some of them are coughing or sneezing, and you can’t move away. I wear a standard surgical mask in the airport because it is easier to pull down at the TSA checkpoint, then switch to an N95 or KN95 once I am through security,” says Blumberg.
8. Take the Party Outside if You Can
“A good rule of thumb is that if the outdoors is an option, gather outside. I know that the ability to do this varies depending on where you live and how hot or cold it is,” says Dr. Parikh.
COVID-19 spreads more easily indoors than outdoors, according to the CDC. Since people can’t wear masks while eating and drinking, bringing the party outside reduces the risk of virus transmission.
For people at higher risk for more severe disease, an outdoors setting can provide an extra sense of security, agrees Blumberg.
9. Filter the Air Indoors to Reduce the Risk of Virus Transmission
If your holiday gathering takes place indoors, “Opening windows makes sense to me as a low-cost way to improve ventilation, if weather permits,” Mani says.
As far as investing in a fancy air filter, there isn’t much data to show that’s significantly better than less high-tech options, she adds. “There are lots of great DIY suggestions for improving ventilation in rooms that otherwise don’t have access to fresh air, which seem to work quite well.”
One DIY option, a Corsi-Rosenthal box, uses a square box fan and 4 MERV-13 filters. Cocreated by the dean of the engineering school at the University of California in Davis and a past president of the National Air Filtration Association, this homemade air cleaning system can reduce indoor exposure to airborne particles that contain the virus that causes COVID-19.
If your home or apartment has a central heating, ventilation, and air-conditioning (HVAC) system, you can reduce virus transmission risk by setting the fan to the “on” position rather than “auto” when you have visitors; this will allow the fan to run continuously, even if the heat or AC is not on.
You should also use pleated filters, make sure they fit properly, and change them according to the manufacturer’s recommendations.
“But for most people I think that the first steps for protection are being up to date with vaccination, masking if appropriate, symptom screening, and then maybe testing ahead of time. I would put ventilation after these measures,” Blumberg says.
10. Take Precautions That Protect the Most Vulnerable People in Your Group
“Staying up-to-date with vaccines is still the best way to protect people who are immunocompromised or at high risk for complications from infection. More importantly, this means surrounding people who are immunocompromised with others who are also fully vaccinated; we call this the ‘immune cocoon,’” says Seth Cohen, MD, an infectious-disease physician and the medical director of infection prevention and control at UW Medicine in Seattle.
Since people have different needs when it comes to COVID-19 prevention, it may be worth having an open dialogue about whether somebody at your gathering has specific concerns or wishes that you could help address, Dr. Cohen suggests. “Testing, asking others to minimize community contacts ahead of time, improving ventilation, and making sure people stay home if sick are all important complementary strategies to consider,” he says.
Parikh agrees that you should tailor your behavior to minimize the risk for the most vulnerable member of the group. “It’s like the saying, ‘A chain is only as strong as the weakest link.’ I would think everyone would want to take those precautions if it’s a family member or friend. Logically, you wouldn’t want that person to get sick,” she says.
11. Wash Hands Frequently To Help Prevent the Spread of Germs
Although most of these viruses are primarily transmitted via the respiratory route, some like RSV may be transmitted by contact, and so frequent hand hygiene is also a good idea, says Blumberg.
Wash hands thoroughly (for at least 20 seconds) with soap and water when arriving at and leaving any social gathering, advises the CDC.
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